Apixaban is cost-effective compared with standard of care for stroke prevention in atrial fibrillation

Paul Dorian

Based on randomised trial data and from the UK payer perspective, apixaban is a cost-effective alternative to warfarin and aspirin for stroke prevention in atrial fibrillation patients.

“In view of the increasing demand from healthcare providers and payers to assess the economic value of new therapies, the clinical benefits of apixaban needed to be weighed against increases in drug treatment costs,” write Paul Dorian (University of Toronto, St Mitchael’s Hospital Toronto, Canada) and co-authors in a study published ahead-of-print in the European Heart Journal.


For that, they evaluated the pharmacoeconomic impact of apixaban (Eliquis, Pfizer/Bristol-Myers Squibb) compared with warfarin and aspirin for stroke prevention in non-valvular atrial fibrillation patients who were vitamin K antagonist suitable and unsuitable, from the UK National Health Service (NHS) payer perspective.

Dorian et al developed a lifetime Markov model and analised data from the ARISTOTLE and AVERROES studies, which previously showed better efficacy of apixaban preventing stroke and systemic embolism in atrial fibrillation compared with warfarin and aspirin, respectively. They used the incremental cost-effectiveness ratio (ICER) to measure the relative clinical benefit of apixaban vs. standard of care, which assessed if the benefit was accrued within UK payers’ willingness to pay £20,000 per added quality-adjusted life years (QALYs).

The authors report that in a cohort of 1,000 vitamin K antagonist suitable patients over a lifetime, use of apixaban is predicted to result in 20 fewer strokes or systemic embolism, 44 fewer major bleeds and 21 fewer cardiovascular-related deaths compared with warfarin. “This reduced rate of events resulted in 0.181 QALYs gained at an incremental cost of £2,157 when compared with warfarin, leading to an ICER of £11,909 per QALY gained,” note Dorial et al.

In the analysis of 1,000 vitamin K antagonist unsuitable patients treated with apixaban over a lifetime, compared with aspirin, they are predicted to have 66 fewer strokes or systemic embolism and 57 fewer cardiovascular-related deaths. However, the prediction shows 38 additional major bleeds in the apixaban group and 38 cardiovascular hospitalisations. According to the authors, “Compared with aspirin, apixaban led to 0.268 QALYs gained at an incremental cost of £1,930, resulting in an ICER of £7,196 per QALY gained.”

Three previous studies from the US payer perspective have concluded that apixaban is a cost-effective alternative to warfarin, Dorian et al noted. Even though the current study was analysed from a UK payer perspective, it “enables the assessment of convergent validity of results across different countries and healthcare systems,” they write.

The study was funded by a grant from Pfizer and Bristol-Myers Squibb.